First kidney transplantation from a non-heart-beating donor in the Czech Republic

The long-lasting decline in the number of kidney donors with brain death in recent years is the reason for a quest for new sources of kidney donors in the Czech Republic. One possible source to increase the number of donor kidneys is the program of obtaining kidneys from non-heart-beating donors (NHBDs). Based on previous experience abroad, optimum hospital conditions, and, first of all, three years of experimental work, it was possible to realise an NHBD program for the first time in the Czech Republic, in the Transplant Centre of the Plzen Hospital in early 2002. The first two kidneys were obtained from a donor with a devastating gunshot brain injury (Maastricht criteria, Class III). After machine perfusion (RM3 renal perfusion system, Waters Medical) both kidneys were transplanted into two recipients with chronic renal insufficiency (chronic glomerulonephritis, nephrosclerosis). Both kidneys resumed their function immediately. For immunosuppression, basiliximab (Simulect, Novartis), rapamycin (Rapamune, Wyeth), and methylprednisolone (Urbason solubile forte, Hoechst) were used. To improve renal function, cyclosporine A (Sandimmune Neoral, Novartis) was started later in the course, simultaneously reducing the dose of rapamycin. The postoperative course was uneventful and both patients could be discharged on the twenty-first day of hospitalisation for further care at home.